Pancreatic-enteric fistulary catheterization system

ABSTRACT

A catheterization system for forming dual sutureless anastomoses using two catheters connectable to one another. Once the fistula is healed, a dissolvable connection allows the catheters to separate one from the other and the separated pieces are extruded through normal bowel action. The two catheters may be connected in various ways. In one embodiment, a separate guide member may be used to pull a dissolvable suture through the first catheter. The suture is then attached to the second catheter and the suture may be used to pull the second catheter into contact with the first catheter so that the two catheters are closely connected by the suture. When the suture dissolves, the two catheters separate. In another embodiment, the first catheter has a section formed of a dissolvable mesh. The two catheters may be connected together by any of various types of connections. After a period of time, the mesh dissolves and allows the joined catheters to separate into two pieces.

CROSS-REFERENCE TO RELATED APPLICATIONS

Not applicable.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a catheterization system to create dualsutureless anastomoses between two normally separate spaces in the humanor animal body, and in particular for such a catheterization system forcreating an anastomosis between the pancreatic duct and the small bowellumen.

2. Brief Description of the Related Art

There are various medical reasons for creating an anastomosis, i.e., anopening or connection between two vessels or between two normallyseparate spaces within a human or animal body. See, for example, U.S.patent application Ser. No. 11/229,970, filed Sep. 19, 2005 andpublished on Mar. 22, 2007 as Pub. No. US 2007/0066982 A1, thedisclosure of which is incorporated herein by reference. For example, itmay be desirable to create a passage (a fistula) to allow the drainageof fluids from an organ whose normal outlet is blocked or to create anew passage in any organ where the typical anatomy must be resected fordisease pathology. One such condition involves the blockage of thepancreatic ducts which requires the creation of a communication betweenthe pancreas and the small intestine. It is standard operating techniqueto create a sutured anastomosis over an existing tube/stent involvingthe pancreatic duct and small bowel. This tube is not sutured in placeand passes in the enteric tract within a few days.

BRIEF SUMMARY OF THE INVENTION

The present invention is a catheterization system to create patentepithelialized connections between the epithelium of the pancreatic ductand the epithelium of the small bowel. The present invention does notrequire the use of traditional suture or staples and provides a sealbetween the two organs with decreased risk of leaks or disruptions. Oncethe fistula has healed, the device breaks into two separate pieces to beextruded from the patient's body with normal bowel function.

The catheterization system comprises two flanged catheters: one catheteris for a fistula through the pancreatic duct and the other attachesthrough the parenchyma, the functional element of the pancreas. In orderto create a pancreatic-enteric sutureless anastomosis, a Roux limb orloop of small intestine is created and an enterotomy is made in the Rouxlimb. The flange of the first catheter grips the mucosa of the Roux limbthrough the enterotomy. The first catheter is introduced to thepancreatic duct by means of a guide member, such as a wire, that may beseparate from the catheter or may be incorporated into the catheter asan integral unit. The guide member and catheter penetrate the pancreaticparenchyma and exit through the pancreatic serosal surface. The flangeof the second catheter grips the mucosa of the Roux limb through asecond enterotomy and then connects to the first catheter. When the twocatheters are snuggly joined, two anastomoses are formed—one between themucosa at the first enterotomy and the pancreatic duct and the otherbetween the mucosa of the second enterotomy and the artificial exit fromthe parenchyma.

The two catheters may be connected in various ways. In one embodiment, adissolvable suture is attached to the separate guide member and thefirst catheter. The separate guide member is inserted through the firstcatheter. The first catheter and guide member may be used as a unit asdescribed above to enter the pancreatic duct, penetrate the pancreas andexit through the parenchyma. The guide member is then removed from thefirst catheter and the dissolvable suture is pulled through the firstcatheter. The suture is then attached to the second catheter and thesuture may be used to pull the second catheter into contact with thefirst catheter so that the two catheters are closely connected by thesuture. When the suture dissolves, the two catheters separate and areextruded by normal bowel action.

In another embodiment, one of the first or second catheters has asection formed of a dissolvable mesh made of a material such as vicrylor monocryl and an integral guide member. The two catheters may beconnected together by any of various types of snap-fit or otherconnections. After a period of time, the dissolvable mesh sectiondissolves and allows the joined catheters to separate into two pieces.Once the two pieces separate, they are extruded with normal bowelmovements.

Both catheters include an attachment flange that decreases the risk ofnecrosis to epithelial attachments, thereby decreasing the risk ofstricture, stenosis or leaks.

This device allows more efficient operating maneuvers for the surgeon,thus decreasing operative times and operative complications.

The features of the present invention may be used with other devices,such as gastrostomy and jejunostomy tubes. The process of the presentinvention may also be applied to laparoscopic procedures, thusfacilitating conversion of difficult open pancreatic procedures to morefacile minimally invasive procedures. Potentially the present inventionmay be applied to all intestinal anastomoses in both open and closedprocedures.

These and other features, objects and advantages of the presentinvention will become better understood from a consideration of thefollowing detailed description of the preferred embodiments and appendedclaims in conjunction with the drawings as described following:

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a first catheter.

FIG. 2 is a perspective view of an embodiment of a second catheter.

FIG. 3 is a perspective view of an embodiment of a guide member.

FIG. 4 is a perspective view of the first catheter of FIG. 1 attached tothe guide member of FIG. 3 by a dissolvable suture.

FIG. 5 is a perspective view of the guide member assembled to the firstcatheter.

FIG. 6 is an exploded perspective view illustrating guiding theassembled first catheter and guide member into the pancreatic duct.

FIG. 7 is a perspective view illustrating securing the Roux limb to thepancreatic duct.

FIG. 8 is a perspective view illustrating the attachment of the secondcatheter to the first catheter.

FIG. 9 is a perspective view illustrating the second catheter secured tothe first catheter.

FIG. 10A is a perspective view of an alternative embodiment of the firstcatheter. FIGS. 10B-E are cross sections of the guide section and guidewire along the lines 10B-10B through 10E-10E, respectively, of FIG. 10A.

FIG. 11 is a perspective view of an alternative embodiment of the secondcatheter.

FIG. 12A is a partial perspective view of the first and second cathetersillustrating a frictional means of attachment of the first and secondcatheters.

FIG. 12B is a partial perspective view of the first and second cathetersillustrating a elastic protuberance and hole means of attachment of thefirst and second catheters.

FIG. 12C is a partial perspective view of the first and second cathetersillustrating a rib and complementary recess means of attachment of thefirst and second catheters.

FIG. 12D is a partial perspective view of the first and second cathetersillustrating a screw means of attachment of the first and secondcatheters.

FIGS. 13A and 13B are perspective views of an alternative embodiment tothat of FIG. 12C.

FIGS. 14-18 are perspective views showing the steps in one method ofattachment of the catheters of the alternative embodiments of FIGS. 10Aand 11.

FIGS. 19 and 20 are perspective views showing the steps in one method ofattachment of the catheters of the alternative embodiments of FIGS. 13Aand 13B.

DETAILED DESCRIPTION OF THE INVENTION

The catheterization system of the present invention comprises twoflanged catheters: one catheter is for a fistula through the pancreaticduct and the other attaches through the parenchyma, the functionalelement of the pancreas. The catheters described herein are desirablymade of any of various elastic materials, such as latex, vinyl chlorideor Silastic ® silicone rubber. Silastic ® silicone rubber will notpromote an inflammatory reaction at the site where the guide memberexits the surface of the pancreas. However, an inflammatory reaction maybe desirable to better seal the exit site. For the purpose of promotingan inflammatory reaction, latex is the preferred material.

An embodiment of the present invention is described following withreference to FIGS. 1-9.

An embodiment of a first catheter 10 is shown in FIG. 1. The firstcatheter 10 is an elongated, generally tubular elastic structure havinga hollow interior 11 communicating with a first opening 12 at a firstend 13 and a second opening 14 at a second end 15. The first catheter 10may be provided with a flare toward the first end 13. A flange 16 isdisposed around the first opening 12. The flange may, for example, be ofthe type disclosed in U.S. patent application Ser. No. 11/229,970, citedabove, which is an everted rim of the first end 13 and may be corrugatedto minimize necrosis of the epithelium. The first catheter 10 may alsoincorporate fenestrations 17 disposed along at least a portion of thelength of the first catheter 10 and communicating with the hollowinterior 11. The first catheter 10 also incorporates means for attachinga dissolvable suture. Preferably, the means for attaching a dissolvablesuture comprises a ring 18, preferably of metal, disposed around theopening 12 and a gap 19 through the flange 16 and the first end 13 toallow a suture to be passed through the gap 19 and around the ring 18.

An embodiment of a second catheter 20 is shown in FIG. 2. The secondcatheter 20 is an elongated, generally tubular structure that may beshorter than the first catheter 10. The second catheter 20 has a hollowinterior 21 communicating with a first opening 22 at a first end 23 anda second opening 24 at a second end 25. Preferably, the second end 25 ofthe second catheter 20 is sized so as to fit snugly within the secondend 15 of the first catheter 10. The second catheter 20 may be providedwith a flare toward the first end 23. A flange 26 is disposed around thefirst opening 22. As with the first catheter 10, the flange may be ofthe type disclosed in U.S. patent application Ser. No. 11/229,970. Thesecond catheter 20 may also incorporate fenestrations 27 disposed alongat least a portion of the length of the second catheter 20 andcommunicating with the hollow interior 21. The second catheter 20 alsoincorporates means for attaching a dissolvable suture. Preferably, themeans for attaching a dissolvable suture comprises a ring 28, preferablyof metal, disposed around the opening 22 and a gap 29 through the flange26 and the first end 23 to allow a suture to be passed through the gap29 and around the ring 28.

With reference to FIG. 3, a separate guide member, preferably a guidewire 30, is provided to be used in conjunction with the first catheter10. The guide wire 30 is generally tapered from a first end 31 to asecond end 32. The guide wire 30 may be substantially straight along itslength or may be hooked or curved as shown in FIG. 3 to facilitate itspassage into the pancreatic duct. The second end 32 terminates in apenetrating point 33 which is preferably rounded or blunt forpenetrating through the parenchyma. The first end 31 provided means forattachment of a dissolving suture. The means for attachment may be acircumferential recess 34 in the first end 31.

A length of dissolvable suture 40, such as 2-0 vicryl, is attached tothe first catheter 10 and the guide wire 30 by tying one end of thesuture 40 to the ring 18 as described above and tying the other end ofthe suture 40 to the circumferential recess 34 in the guide wire 30.Then, as shown in FIG. 5, the guide wire 30 is slipped into the firstopening 12 and through the first catheter 10 until the second end 32 ofthe guide wire 30 protrudes from the second opening 14 of the firstcatheter 10. It is desirable that the second end 15 of the firstcatheter 10 be tapered for a smooth transition between the firstcatheter 10 and the guide wire 30 in order to minimize tissue damage anddrag. Once the first catheter 10 and the guide wire 30 have beenassembled together, they can be employed as a unit.

The following description is given for illustrative purposes withrespect to a Roux limb of the small intestine. However, the presentinvention is not limited to use with a Roux limb. For example, a loop ofjejunum could be used in the practice of the present invention.Similarly, the stomach and the Roux limb or jejunal limb could be usedin combination. The present invention may also be used in a pancreaticpseudocyst with anastomosis to the stomach, Roux limb or jejunal loop.With respect to a Roux limb 50 as shown in FIGS. 6-9, in order to createa pancreatic-enteric sutureless anastomosis, the Roux limb 50 is createdand an enterotomy 51 is made in the Roux limb 50. The assembled firstcatheter 10 and guide wire 30 are guided through the duct 52 of thepancreas 53. The guide wire 30 penetrates the pancreas 53 and exits theparenchyma at an exit opening 54. The flange 16 of the first catheter isinserted through the incision 51 where it is positioned to grip themucosa of the Roux limb through the enterotomy 51. Alternatively, theassembled first catheter 10 and guide wire 30 may first be insertedthrough the open end 55 of the Roux limb 50 and out through theenterotomy 51 before being guided into the pancreatic duct 52. Also, asdescribed below, a donut shaped member 90 may be employed to assist inplacing the flange 16 within the enterotomy 51. In any of theseapproaches, the Roux limb 50 is thereby secured to the pancreas 53 bythe flange 16 of the first catheter 10 as shown in FIG. 7.

The guide wire 30 is then pulled through the first catheter 10 draggingthe suture 40 with it. As shown in FIG. 8, the guide wire 30 with theattached suture 40 is passed through a second incision 56 in the Rouxlimb and out the open end 55 of the Roux limb 50. The end of the suture40 is then detached from the guide wire 30, passed through the hollowinterior 21 of the second catheter 20. The second catheter 20 is passedinto the open end 55 of the Roux limb 50 until the second end 25 of thesecond catheter 20 enters snuggly into the second end 15 of the firstcatheter. As shown in FIG. 9, the suture 40 is then attached to the ring28 of the second catheter 20. The flange 16 of the first catheter 10 andthe flange 26 of the second catheter 20 form two anastomoses—one betweenthe mucosa at the first enterotomy 51 and the pancreatic duct 52 and theother between the mucosa of the second enterotomy 56 and the exitopening 54 from the parenchyma. After sufficient time for theanastomoses to heal, the suture 40 dissolves, the two catheters 10, 20separate and are extruded by normal bowel action.

In another embodiment of the present invention as shown in FIGS. 10-13B,a first catheter 60 has a dissolvable section 61, which may be formed ofa dissolvable mesh made of a material such as vicryl or monocryl, and anintegral guide member such as guide wire 93. Although this embodiment isdescribed with reference to the dissolvable mesh section 61 formed inthe first catheter, the dissolvable mesh section 61 may alternatively beformed in the second catheter 70. The first catheter 60 is an elongated,generally tubular structure having a hollow interior 62 communicatingwith an opening 63 at a first end 64 and a guide section 66 at a secondend 67. The first catheter 60 may be provided with a flare toward thefirst end 64. The first catheter comprises a first section 65 betweenthe opening 63 and the dissolvable section 61 and a second section 68between the dissolvable section 61 and a guide section 66. A flange 92is disposed around the opening 63. The flange may, for example, be ofthe type disclosed in U.S. patent application Ser. No. 11/229,970, citedabove, which is an everted rim of the first end 64 and may be corrugatedto minimize necrosis of the epithelium. The first catheter 60 mayincorporate fenestrations 69 disposed along at least a portion of thelength of the first section 65 and/or the second section 68. Thefenestrations 69 communicate with the hollow interior 62. The secondsection 68 also comprises means for attachment to the second catheter 70as described more fully below.

The first catheter 60 may be substantially straight along its length ormay be provided with a hook or curve in at least a portion of the secondsection 68 and/or the guide section 66. The entirety of the secondsection 68 is a continuation of the hollow interior 62 and incommunication with the opening 63, while some or all of the guidesection 66 may be a continuation of the hollow interior 62 with a guidewire 93, preferably metallic, disposed in the guide section 66. Thedisposition of the guide wire 93 in relation to the wall 94 of the guidesection 66 is shown in FIGS. 10B-E, which are cross sections of theguide section 66.

An embodiment of a second catheter 70 is shown in FIG. 11. The secondcatheter 70 is an elongated, generally tubular structure that may beshorter than the first catheter 60. The second catheter 70 has a hollowinterior 71 communicating with a first opening 72 at a first end 73 anda second opening 74 at a second end 75. The second catheter 70 may beprovided with a flare toward the first end 73. A flange 76 is disposedaround the first opening 72. As with the first catheter 60, the flange76 may be of the type disclosed in U.S. patent application Ser. No.11/229,970. The second catheter 70 may also incorporate fenestrations(not shown) disposed along at least a portion of the length of thesecond catheter 70 and communicating with the hollow interior 71. Thesecond catheter 70 is provided with means for attachment to the meansfor attachment of the second section 68 of the first catheter 60.

The means for connection of the two catheters 60, 70 may be any ofvarious types of snap-fit or other connections. As shown in FIGS. 10, 11and 12C, the first catheter 60 may be provided with a plurality of ribs80 along at least a portion of the exterior surface of the secondsection 68. The second catheter 70 may be provided with a plurality ofcomplementary recesses 81 on at least a portion of the interior surfaceof the second end 75. In this embodiment, after the guide section 66 ofthe first catheter 60 is removed as described below, the second end 75of the second catheter 70 is sized to pass over the remaining portion ofthe second section 68 of the first catheter 60 and to elastically engagethe plurality of ribs 80 with the plurality of complementary recesses81. Alternatively, as shown in FIGS. 13A and 13B, the second catheter 70may be provided with a plurality of ribs 88 on at least a portion of theexterior surface of the second end 75. The first catheter 60 may beprovided with a plurality of complementary recesses 89 along at least aportion of the interior surface of the second section 68. In thisalternative embodiment, after the guide section 66 of the first catheter60 is removed as described below, the second end 75 of the secondcatheter 70 is sized to pass into the remaining portion of the secondsection 68 of the first catheter 60 and to elastically engage theplurality of ribs 88 with the plurality of complementary recesses 89.

Other means for connection are shown in FIGS. 12A, 12B and 12D. In FIG.12A, at least a portion of the interior surface of the second end 75 ofthe second catheter 70 is provided with a frictional surface 82 forfrictionally engaging a complementary frictional surface 83 on at leasta portion of the exterior surface of the second section 68 of the firstcatheter 60. In FIG. 12B, at least a portion of the second end 75 of thesecond catheter 70 is provided with a plurality of openings 84 forelastically engaging a plurality of complementary elastic protuberances85 on at least a portion of the exterior surface of the second section68 of the first catheter 60. In FIG. 12D, at least a portion of theinterior surface of the second end 75 of the second catheter 70 isprovided with a set of screw threads 86 for threadedly engaging acomplementary set of screw threads 87 on at least a portion of theexterior surface of the second section 68 of the first catheter 60. Aswith the alternative embodiment of FIGS. 13A and 13B, any of the otherembodiments described above with respect to FIGS. 12A, 12B and 12D maybe reversed so that the second end 75 of the second catheter 70 is sizedto pass into the remaining portion of the second section 68 of the firstcatheter 60.

The following description is given with reference to FIGS. 14-20illustrating the present invention with respect to a Roux limb. Otherthan the Roux limb, the present invention may be used in variousalternative scenarios known to those of ordinary skill in the art sinceclinical practice depends on the surgeon's preference and the patient'sanatomy. In order to create a pancreatic-enteric sutureless anastomosiswith a Roux limb 50 and the embodiment of FIGS. 10-13B, the Roux limb 50is created and an enterotomy 51 is made in the Roux limb 50. Adonut-shaped member 90 with a bore 91 narrower than a diameter of theflared portion of the first end 64 is placed over the guide section 66and passed down the first catheter 60 toward the flared portion in orderto draw in and narrow the elastic flange 92 as shown in FIG. 14. Asmaller enterotomy 51 is possible when using a narrowed flange 92. Thenarrowed flange 92 is inserted into the smaller enterotomy 51 and whenthe donut shaped member 90 is withdrawn, the flange 92 expands to itsoriginal shape inside the enterotomy 51 as shown in FIG. 15 where it ispositioned to grip the mucosa of the Roux limb 50. The guide section 66of the first catheter 60 is then guided through the duct 52 of thepancreas 53. The guide section 66 penetrates the pancreas 53 and exitsthe parenchyma at an exit opening 54. Alternatively, the first catheter60 may first be inserted through the open end 55 of the Roux limb 50 andout through the enterotomy 51 before being guided into the pancreaticduct 52. In either case, the Roux limb 50 is thereby secured to thepancreas 53 by the flange 92 of the first catheter 60 as shown in FIG.15.

As shown in FIG. 16, the guide section 66 is then passed through asecond incision 56 in the Roux limb. The second catheter 70 is passedinto the open end 55 of the Roux limb 50 via the Seldinger Techniqueuntil the second end 75 of the second catheter 70 passes over the secondsection 68 of the first catheter 60. The Seldinger Technique is a methodof introducing a catheter into a hollow lumen or cavity. A hollow needleis used to enter the lumen. A guidewire is passed through the needle andthe needle is withdrawn. The catheter is then advanced over theguidewire. In this case, the guide section 66 acts as the guidewire inthe Seldinger Technique. Note that in this embodiment, the means forconnecting the catheters 60, 70 must be disposed on the exterior of thefirst catheter 60 and on the interior of the second catheter 70.

As shown in FIG. 17, the guide section 66 of the first catheter 60protruding beyond the flange 76 of the second catheter 70 is trimmed offand the catheters 60, 70 are squeezed together for a snug fit. As shownin FIG. 18, the flange 92 of the first catheter 60 and the flange 76 ofthe second catheter 70 form two anastomoses—between the mucosa at thefirst enterotomy 51 and the pancreatic duct 52 and the other between themucosa of the second enterotomy 56 and the exit opening 54 from theparenchyma. After sufficient time for the anastomoses to heal, thedissolvable mesh section 61 dissolves in 10-21 days and allows thejoined catheters 60, 70 to separate into two pieces. Once the two piecesseparate, they are extruded with normal bowel movements.

An alternative method of connecting the catheters 60, 70 is describedwith reference to FIGS. 19 and 20, where the means for connecting thecatheters 60, 70 is disposed on the interior of first catheter 60 and onthe exterior of second catheter 70. Rather than using the SeldingerTechnique, after the first catheter is inserted into the pancreatic duct52 and out through the parenchyma of the pancreas 53. The guide section66 and any protruding portion of the second section 68 is trimmed flushwith the surface of the pancreas 53. The second catheter 70 is placedinto the open end 55 of the Roux limb 50 and then through the secondenterotomy 56. The second end 75 of the second catheter 70 passes intothe second section 68 of the first catheter 60 and snugged for a securefit.

The features of the present invention may be used with other devices,such as gastrostomy and jejunostomy tubes. The process of the presentinvention may also be applied to laparoscopic procedures, thusfacilitating conversion of difficult open pancreatic procedures to morefacile minimally invasive procedures. It is intended that the presentinvention may be applied to all intestinal anastomoses in both open andclosed procedures.

The present invention has been described with reference to certainpreferred and alternative embodiments that are intended to be exemplaryonly and not limiting to the full scope of the present invention as setforth in the appended claims.

1. A catheterization system, comprising: a first catheter having ahollow interior communicating with a first opening at a first end and asecond opening at a second end, said first end having a flange disposedat said first opening; a second catheter having a hollow interiorcommunicating with a first opening at a first end and a second openingat a second end, said first end having a flange disposed at said firstopening; means for connecting said first catheter to said secondcatheter at respective second ends to form a connected dual catheter;and dissolvable means for separating said connected dual catheter into afirst nondissolvable portion comprising said flange of said firstcatheter and a second nondissolvable portion comprising said flange ofsaid second catheter.
 2. The system of claim 1, further comprising aguide member associated with said first catheter.
 3. The system of claim2, wherein said dissolvable means comprises a dissolvable section of oneof said first catheter and said second catheter.
 4. The system of claim2, wherein said dissolvable means comprises a dissolvable suture, meansfor attaching said dissolvable suture to said first catheter, and meansfor attaching said dissolvable suture to said second catheter.
 5. Thesystem of claim 3 wherein said guide member comprises a guidewireintegral to said second end of said first catheter, said guidewirehaving a penetrating tip.
 6. The system of claim 4 wherein said guidemember comprises a guidewire having a first end comprising means forattaching a suture and a second end comprising a penetrating tip.
 7. Thesystem of claim 4 wherein said means for attaching said dissolvablesuture to said first catheter comprises a metal ring disposed at saidfirst opening and a gap for passing a suture around said metal ring, andwherein said means for attaching said dissolvable suture to said secondcatheter comprises a metal ring disposed at said first opening and a gapfor passing a suture around said metal ring.
 8. The system of claim 3wherein said dissolvable section comprises a dissolvable mesh.
 9. Thesystem of claim 3, wherein said first catheter comprises means disposedon said second end for threadedly engaging said second end of saidsecond catheter and wherein said second catheter comprises meansdisposed on said second end for threadedly engaging said second end ofsaid first catheter.
 10. The system of claim 3, wherein said firstcatheter comprises means disposed on said second end for frictionallyengaging said second end of said second catheter and wherein said secondcatheter comprises means disposed on said second end for frictionallyengaging said second end of said first catheter.
 11. The system of claim3, wherein said first catheter comprises a plurality of ribs disposed onsaid second end, and said second catheter comprises a plurality ofcomplementary recesses disposed on said second end for elasticallyengaging said plurality of ribs.
 12. The system of claim 3, wherein saidfirst catheter comprises a plurality of protuberances disposed on saidsecond end, and said second catheter comprises a plurality ofcomplementary holes disposed on said second end for elastically engagingsaid plurality of protuberances.
 13. The system of claim 1, wherein saidfirst catheter and said second catheter comprise fenestrationscommunicating with respective said hollow interiors.
 14. The system ofclaim 1, wherein said first end of said first catheter comprises aflared portion terminating in said first opening and said first end ofsaid second catheter comprises a flared portion terminating in saidfirst opening, means for compressing said flared portion and narrowingsaid flange, comprising a member having a bore characterized by adiameter smaller than a diameter of said flared portion.